Applying systems thinking to commissioning: who will be the future system leaders?

I often wonder just who the leaders in the commissioning landscape will be moving forwards. Times are changing rapidly, organisational boundaries are blurring and merging and new integrated teams promise to be one of the enablers of different ways of working.

To survive in this new landscape will take a crucial shift in our awareness of the situations in which we operate and the ways in which we think. Fragmented, linear thinking is no longer appropriate for dealing with the wealth of complexity in today’s world. It is going to be ever more important to grow the state of mind from which one operates in order to survive. We should be mindful that what we are looking at is determined by how we are looking and a process of stepping outside of our normal ways of thinking may be required. (Jan de Vische, 2014)

Those of us who engage with systems thinking are very aware that, ‘A systems approach begins when first you see the world through the eyes of another.’ (Churchman, 1968) and some core concepts of systems thinking are ‘gaining a bigger picture (going up a level of abstraction) and appreciating other people’s perspectives.’ (Chapman, 2004) These are easy things to say, I guess, but much harder to put in practice if you are not used to it and yet I feel they will be important skills for the leaders of the new commissioning landscape as they lead within a wider system and not just the constraints of one organisation.

To see the wider system people must first move beyond the strongly bonded relationship they have with their current organisation, which will inevitably be hierarchical. Fritjof Capra in his book, The Systems View of Life, reminds us that people see their position in a hierarchy as part of their identity. Therefore, to me it is easy to imagine why people may not want to see other perspectives as they are happy to see the world as they currently do and feel happy with their current identity within the existent hierarchy.  Because of this, the demise of organisational boundaries and traditional hierarchies may generate some existential fears and I wonder to what degree this will hinder people’s ability to organically adapt to their new circumstances.

On a positive note though, it may act as a catalyst for new, emergent thinking. I wonder if those caught in this huge and prolonged change realise that there is a different kind of power they can harness instead of the traditional power gained through hierarchical positioning? It is the power to empower others. Capra tells us that the network is the ideal structure for exerting this kind of power, which, in my mind, fits perfectly with the newly emerging commissioning landscape. I feel that future system leaders will be those who can effectively facilitate the new connectedness, rather than resist it. They will be the ones who can develop rich connections, recognise new centres of power, grow alliances, partnerships and new relationships, learn their way forward with others and not be afraid of failure. They will be the ones who support new mechanisms of learning, grow shared values as oppose to being chained to one organisational culture and they will nurture a true sense of community.

The systems leaders will be those who can effectively work with the flux, rather than hide from it and they will be committed to the success of the whole, rather than one part of it. They will be able to focus on similarities rather than differences and will have a committed focus on deeper learning. Their tolerance for uncertainty will be enhanced, they will embrace new freedoms and they will accept the need for a longer-term focus.

I believe the new way forward has the potential to open up a plethora of freedoms and choices, which I believe will be hugely beneficial, because as von Foerster reminds us, ‘the more freedom one has, the more choices one has, and the better chance that people will take responsibility for their own actions. Freedom and responsibility go hand in hand.’ (Ison, 2010)

 

 

Remembering Peter Block’s Community

On discussing the fragmented community and its transformation, Peter Block tells us, ‘the essential challenge is to transform the isolation and self-interest within our communities into connectedness and caring for the whole. The key is to identify how this transformation occurs. We begin by shifting our attention from the problems of community to the possibility of community.’ He also reminds us that the community should be a place where we are emotionally, spiritually and psychologically a member.

I don’t know about you, but I literally cannot function properly if I don’t feel connected in these ways. I’m not a ‘half in, half out’ type of person. I’m a 100% in person. I want a deep connection with my communities, I want to feel close to the people I deal with regularly, I want to experience the world as they do. I want to feel free to express myself whilst remaining psychologically safe. I want to be able to challenge thinking in a constructive way (both within my community and within myself) and I want to feel proud to be part of a larger whole.

I want to consider the wider purpose, give to that purpose unselfishly and focus on interdependence more than independence. I want to break down the doors of isolation and be seen not just as a stranger passing through, but as an active investor and creator of our collective space. I want to explore our community’s authenticity and identify where we can together trade problems for opportunities.

I want to build and share social capital. I want to use my skills to the full and share them with others. I want quality relationships, new conversations and to evolve in an organic way. Don’t ever think of forcing me in your direction without giving me choices or I will at best resist and at worst completely disengage.

I want to be able to act, not be done to. That is when I will choose to help build our collective desired future. If this takes different kinds of conversations, ones we have not had before, then that is the way I want to go. I don’t want the old and stale, I want the new and exciting. I want mutual assistance and trustworthiness and most of all I want to learn and feel alive.

I want to be around people who have the same values as me, who respect my principles and ethics and give me the freedom to be accountable. I want to be in contact with people who help develop my learning and I want the freedom to express how our future world might look. I want to be engaged in conversations constructively, not brushed off like an irritating insect and I want us to jointly explore our learning and developing possibilities.

As a systems thinker I want to understand and come to terms with the current story……..and then seek to build a new one. I want to do it in a way that allows us to create together. I don’t want to project the accountability for development and growth onto others.

In my communities, your identity is my identity. I want that identity to be mutually agreed, not enforced upon me or I cannot truly adopt it or be accountable for it. I want a sense of belonging, where all voices are heard, not just the chosen few. Only then can I truly focus on our collective gifts, rather than our deficiencies.

I want to be part of the vision, part of the plan and feel a deep sense of commitment through this engagement. You can’t build commitment without conversations though, so if you want my loyalty then you have to engage with me.

‘The way we change the room is by changing the conversation’ (Community, Peter Block)

 

Crossing the Bridge

I came across this blog recently and was very impressed by its content and the thinking that it sparked in me.

http://blogs.lse.ac.uk/impactofsocialsciences/2017/04/27/the-ngo-academia-interface-obstacles-to-collaboration-lessons-from-systems-thinking-and-suggested-ways-forward/

The text that initially caught my eye was this,

‘Most studies identify a need for “knowledge brokers” not only to bridge the gap between the realms of science and policy, but also to synthesise and transform evidence into an effective and usable form for policy and practice. An essential feature of knowledge brokers is that they understand the cultures of both worlds.’

I believe the skill of the ‘knowledge broker’ is absolutely key for systems thinkers working with and in organisations and trying to disseminate the practice. Some of those who have come through the Open University Systems Thinking in Practice courses have good skills in this area, I think. I believe that is why we sometimes have fewer issues with the ‘my method/ model is better than yours’ and the ‘no-one wants to know about systems thinking’ arguments than some. It may be because the course did something unique for us – it taught us not only the academic aspects of systems thinking but how to practically use it and how to develop ourselves at the same time. We have to develop our praxis in a way that embodies the understanding of the cultures of both the academic and practitioner worlds………or we wouldn’t be able to use systems thinking effectively.

Personally, I feel like I can work with organisations using systems thinking and engage in the academics because I can ‘cross the bridge’ from one side to another when I need to and I can guide others across the bridge (not all the time but certainly sometimes). It is the area on the ‘bridge’ where you learn how to make it work. I find it quite absurd to witness the two cultures (academic and practitioner) at loggerheads sometimes because without each other we are all nowhere. We need to cross that bridge and meet in the middle sometimes. It was never meant to be a drawbridge……I don’t think!

I spoke to an ex employer the other day. A Chief Executive who I have a lot of respect for. She said to me, ‘There are 2 groups of people – those who want to fight with each other about who is right academically and those who just want help to translate the academics into practical application. Until we can all learn to talk to one another in a helpful way then we are never going to move forward, even if we want to use the methods. If the academics come at us with their harsh academic arguments, we just can’t handle that because that’s not part of our world and if we can’t get across to them our challenges and how we need help, without being put off by their harsh arguments, then we are never going to be able to transform the good stuff into something useable.’ I wonder how clever we really are, then, if we don’t put some effort into developing that area in between……..the area on the bridge?

As a systems practitioner, my main progress has been in translating what I have learnt into practical application. That was part of the OU course – putting systems thinking into practice.  I don’t bark words such as ‘viable system model’ etc in people’s faces repeatedly, in organisations, wondering why they don’t listen. I demonstrate, I show where value is added, I enable appropriate outcomes….and then I tell people how to do it themselves. I believe in ‘show don’t tell’ as I think this helps people to visualise. If they can visualise the process you go through to translate the academics into practice they often find it easier to apply it themselves, but they need a demonstration first. We spend far too little time helping people visualise what the value could be for them and how they can go through a thinking process to apply the academics to their real-life situation. We just expect them to trust that ‘the academic knows best’ and use what they are told is the best method. The very nature of the way we expect people to take new thinking on board sometimes can foster the very rejection type of behaviour that we want to overcome.

Would we go into a car showroom and expect a sales person to stand and verbally describe a brilliant car to us and expect us to understand how fast it is or how smooth the ride is by telling us about suspension and engines, when these things are not our area of expertise and we have no understanding of engines or suspension?…..no. We would want to see the car, drive it, see how it feels when we drive over a bump in the road and what it does when we put our foot down on the accelerator. We might then want to know ‘What kind of engine allows that?’ but often only when we have experienced and been impressed by what it can do for us first. So, how do we give people a ‘practice run’ of viable system modelling? How do we allow them to ‘feel’ what it’s like to go through the process of developing a multiple cause diagram? We can’t do it just by telling them how it’s going to feel. We have to help them feel it for themselves.

I did some work for a Clinical Commissioning Group a few years ago to look at some health and care services with a view to developing a completely new model of care. I was absolutely sure that systems thinking, in particular viable system modelling, was the correct thing to use. I dropped the words ‘systems thinking’ into the project conversations right at the beginning of the process, only to be met with blank looks. This was highly expected, though. How could I expect anyone to understand the depth of the academic elements if they weren’t engrossed in that area of thinking themselves? My way forward was to undergo systemic inquiry type activities and show the process of thinking, rather than explain what it was. I used their language and over time I gently fed in more and more of the academic explanations and different language. I didn’t say, ‘and this is viable system modelling and you should use it more.’ I just showed them what I was looking at and what my observations said to me. I showed them how things fit together and what was causing staff to feel so desponded with their current situation. I got people on board by showing a depth of understanding about their current situation. I drew multiple cause diagrams with them and was amazed when they suddenly saw what they had previously been blind to, even though they had been encountering it on a daily basis.

It was only at the end, when I had helped people through the thinking process that they could visualise and understand the power of the process, the potential benefits, the added value and the outcomes from using such methods/ models and techniques. Some of the people on that project became real advocates of systems thinking after that. Now, how long do you think it would have taken me to convince them if I hadn’t used the ‘show don’t tell’ way?

Don’t get me wrong, I think we should fly the flag for systems thinking but there’s a way to do it…….not by having the harsh academic argument in the practical world but by crossing the bridge, getting to a place in the middle and then the flag will fly itself. But, we all have to be willing to compromise and come half way.

Remember…….if you don’t ever want to cross the bridge, how will you ever get to the other side?

 

A look back at my 10 year systems thinking journey

I’m reliably informed, by Google, that a lot can happen in ten years. Decades can see changes in norms and attitudes, see scientific, technical and medical advances and uncover new findings and theories in social sciences. We can completely change the shape of accessibility of information in ten years and I can learn how not to jam my hand between the bedroom door and the chest of drawers…..well, nearly. I still do that sometimes! And, in ten years I can go from my first introduction to systems thinking, in 2007 to a systems practitioner, still learning and always developing.

I was remembering my first major project this morning. It was looking at whether a Primary Care Trust was doing all it could to support appropriate prescribing for Type II diabetic patients back in 2007. It was via this project that I had my first real-life attempt at devising and using a hybrid methodology, incorporating aspects of Soft Systems Methodology, Hard Systems, Systems Dynamics and Viable Systems Modelling. Looking back at that piece of work, it struck me how I explicitly concentrated on the concept of autonomy. It felt natural to do so at the time and only now do I really understand its significance. I tried my hand at rich pictures, systems maps, utilising the CATWOE mnemonic, conceptual modelling, multiple cause diagramming and influence mapping. I made use of systems tools to open up perception, understand culture and to support complex decision making. I didn’t make a big deal of it at the time, but I was able to identify levels of recursion, systems and sub-systems in my situation of interest. I engaged a number of multi-agency stakeholders using systems thinking, identified how current policy had not been derived from appropriate information and I was able to identify how previous planning had been done. I started experimenting with the boundaries of acceptability of the language of systems thinking and began widening my views.

The personal learning was huge. I became very aware of the importance of self-knowledge – of unconscious prejudices, values and how I, personally, reacted to others.

I directly applied my systems thinking to projects within my workplace. I didn’t know it then but the way I worked, learned, developed and influenced others was going through a period of metamorphosis. It would never again look the same as it had before I came across systems thinking.

Outside of the workplace, in an academic capacity, I dipped my toe into the environmental decision making arena in relation to my systems thinking. Environmental issues are a fascinating area of interest for me and a piece of work on deforestation meant I had the diversity of learning I had craved for a long period of time. Why deforestation? I’m a passionate tree lover…..yes, really! Keep it to yourself though!

I also started to draw in techniques of innovation and user centred design to my systems practice, which I thoroughly enjoyed, and by 2009 I was able to see the complimentary elements of a number of types of thinking coming together in an extremely powerful way. My perspectives of everything in life were changing and I loved it.

At this point I believed that finding a supportive systems thinking community to network with might be to my advantage. I needed to talk about my work, share my experiences and hear the experiences of others. I did find such a community and engaged in as participative a way as I could. It was through this community that I was introduced to a different kind of systems thinking arena. An arena where systems thinking meant so many more things (some of which I would class as systems thinking and some I definitely would not). I talked a lot, learned a lot and felt happy with my choice. Based on my new conversations, I was able to formulate myself an updated development plan, incorporating aspirations to set up my own website, become self-employed and continue to share my thoughts and ideas with a wider audience.

I was now very firmly in the arena of systems thinking and at work I was routinely managing systemic change. I was loyally developing my praxis and began engaging with situations using systemic inquiry. I was able to frame situations differently, work with cultural and ethical sensitivity (or so I thought) and improve cross-organisational communication, based on what people required. I undertook projects on health inequalities in maternity care, how to help GP Consortia take over local health care commissioning and hospital discharge. I was routinely using Soft System Methodology, Systems Dynamics, Critical Systems Heuristics and Viable System Modelling

The environmental decision making popped up here and there, again, in my academic work also and at times I found it a welcome change. Particularly when I touched on the areas of marine environment and nuclear power, two things that interest me a lot.

I continued to develope my praxis, noticing what things made me engage with a situation and what would make me disengage, when I understood the relational dynamics and very importantly ‘what I was doing, when I was doing what I doing’ and how and when I needed to take a ‘design turn’ in my practice. You never really know how important a phrase like that is until you hit a situation that forces you to do it. I had such a situation in the NHS once. It was an insightful lesson which has served me well ever since. It was in my role as a Commissioning Manager when I wrote a proposal for a piece of work relating to the urgent care response to pandemic flu. It was systemic inquiry focussed and I though the recommendations about how we should approach things were sound but they were rejected by the Urgent Care Board! I was a little shocked as I knew the recommendations were appropriate but I instantly recognised, during the meeting where I was presenting my report, that the Board and I were speaking different languages. My style and wording relating to systemic inquiry meant nothing at all to people who were expecting to see a project/ programme management style with project/ programme management language. Hmmm……what to do? Two totally different languages in the same room and I had to sort it out! So, off I went to ‘take a design turn’ as Ray Ison from the Open University would say and rectify my mistake. I returned the next week with a completely different report, or so they thought! I presented my report and recommendations and it went down a treat. Apparently, my recommendations were, ‘much improved’ now I had done what the Board wanted. The reality was that I took the report away and changed the words systemic inquiry to project……………..and nothing else! It was a huge risk but I was confident that it was down to the inability of the Board to see what was in front of them because they were blinded by a couple of words they were not used to seeing, did not recognise and could not visualise in the context of the topic in hand and my initial inability to translate my language to one they could understand. It took me some time to stop giggling afterwards and it still brings me the odd moment of enlightened joy even today.

From that meeting, I went away to develop myself a learning contract, which prompted me to do some real exploration of my needs as a systems practitioner. It was then that I started to feel the weight and yet the strength in taking full responsibility for my experiential learning and orchestrating my own evolving praxis. My personal development plan at this point was rapidly changing. I undertook a continuing professional development module as part of my MSc and to my utter delight it made use of the viable system model. I have to say that using the VSM to model my development was one of the most powerful things I had ever done and I have repeated the exercise every year since. Don’t be fooled into thinking VSM is for organisational design only, it is far more versatile than that.

Then, before I knew it, I was back working on hospital discharges and this time I touched on social learning systems and communities of practice, the use of which I was critiquing as I went along. At the same time, I took a look at a systems thinking approach to urgent care redesign. Both big projects. Both extremely motivating and both were the sources of a rich learning experience.

Over the last ten years, I have continued to develop my practice by using systems thinking to improve urgent care escalation processes, input into emergency planning and pandemic flu planning, improve the quality of hospital discharge, form strategy, develop healthcare pathways, improve quality assurance, develop healthcare services, identify risk, flit between operational and strategic management, appropriately allocate healthcare funding, develop  new models of care and undertake a number of transformation and change projects. I’ve managed to get people on board with some of my techniques, develop and facilitate workshops and make large scale, multi-agency interventions. I’ve delivered many a training session on systems thinking, taught people the diagramming, the models, the methods and the concepts and I’ve supported and coached others to develop their own systems practice. I’ve used systems thinking in organisations, across organisations, as a consultant, as a trainer and on myself. I have to say, it’s been quite a journey! And, yes, I set up my website, got started as an independent consultant and continued to develop my networks. I refreshed my development plans to incorporate the cybernetics of self and how to develop mental toughness and I’m now on the next stage of my journey.

I’ve moved on from beginner over the last ten years. However, I will always remain a learner. Throughout it all there have been many ups and downs, many times of discomfort, many disagreements and things I will never resolve and also many times of delight, of insight, of pride in my fellow practitioners and excitement when someone new takes on board systems thinking for the first time. I often reflect on my past ten years and the advice I would give to myself at the start of the journey, if I could travel back in time. I will leave you with some of the things I would whisper into my own ears, if I knew then what I know now:

1.       When you are new and inexperienced in a discipline you will come across people who will not listen to you because you are new and inexperienced. You might think this will disappear over time. It won’t. You will hit this problem because you are young, because you are older, because you are male, because you are female, because you haven’t been an academic, because you are an academic, because you aren’t a practitioner, because you are a practitioner. It doesn’t go away. You will ALWAYS come across people who won’t listen to you or take you seriously. Don’t waste your time making excuses for what it is happening. Instead, use your energy to develop effective strategies for dealing with it. If you come across a situation where every strategy you can think of fails…….move on.

2.       As you move from brand new beginner, understand that you have moved on. You are not at the start line anymore. Continually refresh your development plans. Make sure they continue to challenge and develop you. If they don’t scare you a little, they are not ambitious enough.

3.       There will be times when working life goes wrong. When those you thought you worked well with disappoint you. There will be times when trust is broken and you feel disappointed. There will be times when you are disappointed at yourself. There will be times when you think everything is going wrong and your confidence leaves you. These times are temporary. If you hit times like these, remember why you are in this game. Always, ‘find your way back home’ https://www.ted.com/talks/elizabeth_gilbert_success_failure_and_the_drive_to_keep_creating

 

 

Applying systems thinking to commissioning: remember Donella Meadows

What are the elements in your system of interest? Can you see them? Do you know what they are? In all likelihood, you can see them and you do know what they are. But, do you know how they are interconnected and what the purpose or function of your system is?

Donella Meadows, in her book Thinking in Systems, reminds us that a system must consist of three things: elements, interconnections and a function or purpose. We could say, then, that it is surprising that we can often see the elements more easily than we can identify the interconnections or define the function or purpose, for it is the purpose of the system that defines its behaviour and it is its behaviour that can often give us some cause for concern.

So, what about when we want to use different providers or different types of providers or different departments or teams etc. in our systems when we are commissioning? What happens then? Well, you can change the elements in a system quite easily and the system will remain the same. Just like the cells in the body are replaced on an ongoing basis but we still remain a human being, we don’t completely change. However, there is a BUT. The but is that the system will remain the same when elements are replaced IF the interconnections and purpose(s) remain the same.

This is something that I see being forgotten during times of change and transformation all the time. Elements – be they providers, services, teams, departments or any other element of the system – are changed and yet the interconnections and purpose of the system are not considered. This is especially true regarding interconnections. By interconnections I am talking about the relationships that hold the elements together. This can be anything from a chain of communication to a set of rules, a protocol or a timetable, for example. Imagine a football game. You can change the players (the elements) and it will still be a football game. Change the rules (interconnections) and you may have some sort of ball game, but it may not be football. Those rules might change the purpose or functions of the game and so you might no longer have a football game. You can completely change the elements and the ‘thing’ will remain the same, as long as the interconnections and purpose remains the same.

Donella also reminds us that, as systems practitioners, our focus is on stocks (accumulations of material or information that has built up in a system over time) and flows (material or information that enters or leaves a stock over time) and the operating unit of our system, which is the feedback loop (the mechanism that allows a change in stock to affect a flow into or out of that same stock). The dynamics of our stocks and flows gives us a picture of the behaviour over time of our system. This behaviour over time gives us clues about the underlying structure of our system, which can help us to identify what action we need to take to reinforce or change that behaviour. Yet, in commissioning, we are not always driven to taking action in response to how the system is structured and behaving as a result of that structure. I think this is partly due to pressures which force quick decisions to what is assumed to be an obvious cause and effect. This assumed cause and effect, as we know, is rarely a proven cause and effect and is exactly as described – as ‘assumed’ cause and effect. I also think it is down to there being a lack of general awareness of how systems, with their elements, interconnections and purposes actually work.

Do we always remember that ‘stock’ takes time to change because ‘flow’ takes time to flow? Even if a lot of money is available, it might still be difficult to change ‘stock’ instantly.

What is an example of stock? Well, Donella explains to us that the population can be considered a stock. It has a ‘reinforcing loop causing it to grow through its birth rate, and a balancing loop causing it to die off through its death rate. As long as fertility and mortality are constant (which in real systems they rarely are), this system has a simple behaviour. It grows exponentially or dies off, depending on whether its reinforcing feedback loop determining births is stronger than its balancing feedback loop determining deaths.’ Births and deaths do not usually happen at the same rate, so we need to be aware that there is a time lag when considering our stock. In commissioning,  we shouldn’t be giving up on our improvement or change efforts too soon, having thought they were a failure, when it might be that they just haven’t had the time they need to make a difference.

It might be useful to remember that inflows and outflows are independent and will, of course, happen at different rates. We tend to focus on stocks more than flows, and inflows more than outflows………….don’t just focus on hiring new staff (inflow) but also give some attention to preventing people from quitting or going elsewhere (outflow) – stem the outflow as well as increasing the inflow to increase the stock (number of staff).

This is but a brief snippet of the messages of Donella Meadows that we can apply to our commissioning practice – look for the history of the system, identify its long-term behaviour because this will provide clues about the system’s underlying structure. Identify the structure (the stocks, flows, feedback) which is determining the resulting behaviour. Try and identify your most important input – this is the one that is likely to be most limiting. Remember, overall, aim to enhance total systems properties like growth, stability, diversity, resilience and sustainability rather than focussing on short term ‘fixes that fail’ because they are implemented without knowledge of how the system works as a whole.

‘Systems of information-feedback control are fundamental to all life and human endeavour, from the slow pace of biological evolution to the launching of the latest space satellite….Everything we do as individuals, as an industry, or as a society is done in the context of an information-feedback system’ Jay W Forrester

(Donella H Meadows, Thinking in Systems, 2008)

 

Applying systems thinking to commissioning: are you seeing the Slinky or the hand?

On a slow, sleepy kind of morning recently I found myself revisiting the writings of Donella H Meadows in the form of her book, Thinking in Systems. Only a few pages in, I was reminded of the power in the simplicity of her explanations of systems concepts. I was especially struck by the ease with which she explained one of the central insights of systems theory…..by using a slinky.

For those who haven’t come across this before, I’ve take the following wording from the beginning of her book,

‘Early on in teaching about systems, I often bring out a Slinky. In case you grew up without one, a Slinky is a toy – a long, loose spring that can be made to bounce up and down, or pour back and forth from hand to hand, or walk itself downstairs.

I perch the Slinky on one upturned palm. With the fingers of the other hand, I grasp it from the top, partway down its coils. Then I pull the bottom hand away. The lower end of the Slinky drops, bounces back up again, yo-yos up and down, suspended from my fingers above.

“What made the Slinky bounce up and down like that?” I ask students. “Your hand, you took away your hand,” they say.

So, I pick up the box the Slinky came in and hold it the same way, poised on a flattened palm, held from above by the fingers of the other hand. With as much dramatic flourish as I can muster, I pull the lower hand away. Nothing happens. The box just hangs there, of course.

“Now, once again. What made the Slinky bounce up and down?”

The answer clearly lies within the Slinky itself. The hand that manipulates it suppresses or releases some behaviour that is latent within the structure of the spring. That is the central insight of systems theory.’ (Donella H Meadows, Thinking in Systems, A Primer, 2008)

In commissioning, it is all too easy to focus on external agents, to believe that the cause of problems is ‘out there’ somewhere, to blame and to shift the responsibility from ourselves. We can all too easily forget that some of the problems we encounter are rooted in the complex structure of the ‘messes’ in which we are embedded. The danger in this, of course, is inappropriate commissioning decisions with ineffective outcomes and potentially creating a system that is even harder to navigate.

Take people turning up at A&E unnecessarily, for instance. I have spent years listening to complaints about how patients ‘just like to turn up at A&E.’ This is often followed by a flurry of activity to deflect the activity elsewhere – mainly in the form of communication campaigns, particularly telling the patient to ‘go away – you are in the wrong place!’

But, the problems we have are intrinsically systems problems – turning up at A&E can be seen as an undesirable behaviour which is characteristic of the system structures that produce it. Communications campaigns and the ‘go away’ messages merely focus on the hand and not the Slinky. For that reason, they may not bring about the results their instigators want to see – a reduction in people turning up at A&E. Instead, our energies could be more wisely used if we stop casting blame and see the system as the source of its own problem and find the courage and wisdom to restructure it appropriately to bring about different behaviour.

The ‘trap’ in our thinking that influences us to only see the ‘hand’ can also be a point of enlightenment, if we allow it to be. Wherever there is a trap, there may also be a potential opportunity – an opportunity to recognise the trap, apply systems thinking and transform our systems to produce more desirable behaviours….focussing on the Slinky, not just the hand. We can make the connection between structure and behaviour. We can move away from trying to analyse things in small segmented chunks and instead build an understanding of how our system works as a whole. We can choose to see differently and we can choose to think differently. We can choose to understand the nature of the relationships and we can ask different questions. We can widen our mindset to enable greater insight. Applying systems thinking to our commissioning in this way can help us not only to see the elements in the wider system but to understand the interconnections and commission so that our services ultimately fulfil the purpose for which they are designed.

‘Managers are not confronted with problems that are independent of each other, but with dynamic situations that consist of complex systems of changing problems that interact with each other. I call such situations messes…..Managers do not solve problems, they manage messes.’ Russell Ackoff (Donella H Meadows, Thinking in Systems, A Primer, 2008)

Applying systems thinking to commissioning: remember Barry Oshry!

If you aren’t using the wisdom of Barry Oshry in your commissioning practices, I’m not going to say you should be, but I am going to say you could be.

For those who can’t remember, or who haven’t come across, the basic pattern that Barry tells us develops with great regularity in the widest of organisations and institutions, it looks something like this:

‘There are conditions we all face in whatever organisational position we occupy. Sometimes we are a Top, having overall responsibility for some piece of action; in other interactions we are a Bottom, on the receiving end of initiatives over which we have no control. In other interactions we are Middle, caught between conflicting demands and priorities. In other interactions we are Customers, looking to some other person or group for a product or service we need. So, even in the most complex, multi-level, multifunctional organisations, we are all constantly moving in and out of Top/ Middle/ Bottom/ Customer conditions.’

‘Tops are burdened by what fells like unmanageable complexity; Bottoms are oppressed by what they see as distant and uncaring Tops; Middles are torn and confused between the conflicting demands and priorities coming at them from Tops and Bottoms; Customers feel done-to by non-responsive delivery systems.

Top ‘teams’ are caught up in destructive turf warfare; Middle peers are alienated from one another, noncooperative and competitive; Bottom group members are trapped in stifling pressures to conform.

Tops are fighting fires when they should be shaping the system’s future; Middles are isolated from one another when they should be working together to co-ordinate system processes; Bottoms’ negative feelings towards Tops and Middles distracts them from putting their creative energies into the delivery of products and services; Customers’ disgruntlement with the system keeps them from being active partners in helping the systems produce the products and services they need.

Throughout the system there is personal stress, relationship breakdowns and severe limitations in the system’s capacity to do what it intends to do.’

(Barry Oshry, Seeing Systems 2007)

Sound familiar? Is should do if you are in the changing environment of public services. I’ve seen this, to some extent, in nearly every area I’ve worked. The thing that makes me feel most pain is when it is being explained in terms of the character, motivation and abilities of individuals, just as Barry describes in his book, ‘Seeing Systems’. What follows is the inevitable moving round or dismissing of staff or alienating them to a point where they leave voluntarily. Alongside this comes reorganising and restructuring and then…………..it all happens again! As Barry tells us, that is because the problem is not the staff, nor is it specific to a particular organisation, it is systemic. He terms the inability to see that it is systemic as ‘system blindness.’ I fear we are all blind at least some of the time.

I’ve seen this particularly in times of great change. Let’s face it, that’s most of the time! As a systems practitioner, I tend to identify it when I am also identifying the pathological archetypes of the viable system model, which tends to widen my vision, helps me to ‘zoom out’ from the situation and look at things from a systemic viewpoint, rather than a personal one. For example, if I see failing change programmes where some parts of the organisation do not know why then need to change or who they need to work with, a lack of cohesion and stretched operations, resulting in questions to management around responsibility, staff unable to co-ordinate efforts and rifts throughout a number of levels in the organisation then I can potentially see the ‘identity crisis’ archetype. With this archetype, there may be some strategic issues or organisational design flaws that require attention. However, once it has happened, attention needs to turn to ensuring that people know what is intended, implementing effective co-ordination mechanisms and supporting staff to solve their own problems. Additionally, the potential management turf war, that is causing the mixed messages, also requires resolution. So, I can see the ‘identity crisis’ and I can also see the pattern of the ‘Tops’ being crushed by unmanageable complexity, the Middles becoming more isolated from one another in the confusion and the Bottoms feeling oppressed and disengaging in response to that.

When the Bottoms start to have negative feelings towards the Middles and Tops and when the Middle peers start to compete, I’ve also seen the ‘baronies’ archetype emerge, albeit not very strongly, but I believe it was there. I have seen a group break off and gain independence. They have remained in their own silo and stopped seeing the worth they can get from being part of the wider ‘whole’. I’ve seen competitiveness prevail and learning shielded from other teams. Fortunately, the group were persuaded to recognise the synergies of working as a whole and were able to re-integrate back into the wider system. I was able to recognise what was happening by applying systems thinking to the situation, which made things feel a lot less disturbing. I felt that I could understand it and then use that understanding to carefully start edging things back in the right direction.

Admittedly, it is difficult to actually see the system, if you are embedded in it. Believe you and me, systems practitioners engage in the patterns above all too often, even though they are aware of them and work to recognise them on virtually a daily basis, sometimes. But, you can try to ‘zoom out’ and see the wider system and the systemic nature of the situation you are in. Systems thinking is a model of thinking that can support you in doing that.

To leave you with another quote from Barry Oshry, ‘We humans are systems creatures. Our consciousness – how we experience ourselves, others, our systems, and other systems – is shaped by the structure and processes of the systems we are in.’ (Barry Oshry, Seeing Systems. 2007)

Applying systems thinking to commissioning: knowing what makes a system ‘sick’ can help you minimise the instances of ‘sickness’ in the future

In commissioning, it isn’t all about looking backwards, diagnosing weakness in services and trying to ‘put things right’. It’s quite the opposite. The focus is on creating whatever is required to give the right outcomes going forward. The focus, nowadays, is very much on things like integrating a number of suppliers into the whole system, taking an asset based approach and using levers to stimulate and shape the environment.  New kinds of systems are being created, with different boundaries and an extended repertoire of partners. This doesn’t come without its problems, of course, and a number of people, who are taking a commissioning approach in a new world of integrated public services, are often learning as they go along. That’s not a bad thing either. It’s great that people are learning their way forward together. It fosters a sense of community and encourages deeper thinking and enhanced learning as people deal with greater complexity together.

The tool for handling complexity is organisation. But our belief about what organisation is and how it might work may still belong to a world which is perceived as far less complex. Today, we operate in a much more complex world that we would sometimes like to admit. It challenges us, it makes us uncomfortable, it makes us think differently, it questions our current perspectives. But, if we are really lucky, it stimulates us, excites us and encourages us to strive forward.

It does help, though, if, during times of change, we have some idea of what makes systems (be that an organisation, a service, a group of services or anything that works together as a whole) ‘sick’ so that we can either seek to reduce the level of ‘sickness’ in the first place or be aware of early signs of ‘sickness’ so that we can administer the right medicine to avoid it getting worse.

As different types of organisations become integrated we may well start to see signs of an entangled character as different cultures, which once had to adhere to different criteria, merge together and try to find common ground. There may be some challenges establishing common governance mechanisms/ procedures during this time. We might notice that clear boundaries of responsibility have not yet been established, or appropriate quality indicators and monitoring are not yet in place or that contingencies to reduce risk have not been fully considered. If we understand that this could happen as we are creating something new, then we increase the opportunities to put things in place to prevent any adverse effects. We may need to clarify mission and purpose and who it is we aim to serve and be consciously aware that a new identity could take a little while to establish itself.

It is easy for people to become confused during these times of change. Having moved through a period of potential denial that the change needs to happen they can easily enter a stage of indecision and hesitation as ambiguity prevails, before the bigger picture becomes clear. It is easy, during these times, to default to old job roles and habits, assumptions and expectations. I have seen many instances where operational elements of a previous job role have remained the default focus of people who have moved into different and more strategic roles. Strategic planning was not given the attention it required and instead of embracing the meta-perspective needed, the focus was on micro-managing operations. This caused the organisational focus to be internalised. As a result, changes generally took longer to embed and the risk of the organisation being unable to respond to its environment was significantly increased. Being aware that this might happen and realising the risk that it brings can help us to mitigate against that risk, thus minimising the ‘sickness’ and ensuring that both an internal and external focus are maintained as we move along our journey.

One of the most disruptive ‘sicknesses’ I have encountered during times of change has been in relation to what we call ‘co-ordination mechanisms’ – the things that are in place to prevent operations of the system from causing chaos for one another. For example, a timetable in a school. On the surface, it may be almost invisible. But, without it, the school would be in chaos. It is omission of these near invisible co-ordination mechanisms that can cause our systems to be terribly ‘sick’. It can cause oscillations in performance, turf wars, staff feeling like they are bobbing around in a small boat, all alone, in the middle of a crashing ocean, inter-team disputes and recurring problems and yet the scheduling, the co-ordination, the policies, the planning, the information systems etc. which are vital for maintaining stability are often overlooked, deemed unimportant, invisible, and are often the very last things to get any attention.

These short snapshots of a very few kinds of ‘sickness’ are not exclusive to any one group of people or any one organisation or group of organisations. They happen repeatedly in a number of situations. They can arise when elements of the system, which are required for viability, are not well implemented or are dysfunctional. The system may not be in a state of homeostatic equilibrium and as a result the ‘sickness’ emerges. Left unchecked this will, as best, hinder success and at worst, cause the system to die.

I believe that commissioners who understand organisation and can apply models of organisation, like the viable systems model, to their work have an increased chance of successfully transitioning into a new integrated environment. They gain an understanding of complexity and how it can be matched. They understand and recognise ‘sickness’ and attribute it to systemic failings, rather than blaming individuals – their character, motivation and abilities. They are able to see past the system blindness to which we so often succumb. To quote Barry Oshry,

‘With system sight we can become captains of our own ships as we understand the nature of the waters in which we sail.’

Applying systems thinking to commissioning: what can the viable system model bring to the party?


I first met the viable system model (VSM) in 2008, when I embarked upon my systems thinking journey with the Open University. Admittedly, it wasn’t an easy introduction. There it was, in the corner of my change management party, staring at me like a monster never to be approached. But, me being me, I couldn’t resist poking it with a stick a little bit, just to see how it would react.

I guess it confused me, at first, because I was never quite sure if it was about ‘an organisation’ or ‘organisation.’ This was mainly because the text I was learning from used both phrases/ words so very closely together that I sometimes mixed the two up. I wasn’t the only one either, a number of other colleagues made the same mistake too. It wasn’t long though before I realised it was about organisation (be that ‘an organisation’ or any other kind of system) and then we soon learnt to get along.

Managing complexity and being adaptive is key in the public services in which I have worked and therefore the VSM has been an ideal model to apply because the five systems that exist in the VSM have that purpose in mind. Maintaining a system in a state of homeostatic equilibrium is no easy task but the VSM encourages and supports the learning, adaptation and evolution required to do just that.

When I look at public services I look to see what makes them breathe, what makes their heart beat, what conditions have to exist to enable them to live, what makes them die? I look at how they interact with their environment and within elements of themselves. I look at what interdependencies exist, or don’t exist but should or could. I look to see what the drivers of both internal and external complexity are and are they being absorbed/ matched/ batted away or simply ignored? I look for the energy levels in my system – are people and processes energised, frantic? Are they stressed, fearful or in despair? Or are they asleep, calm, laid back with not a care in the world? I don’t just consider, ‘What is this thing?’ I consider, ‘What does it do?’ These are all clues you see, and when you can spot them and apply them to the VSM you get to know exactly where things are going right or wrong.

The VSM’s party trick, well one of them anyway, is to encourage you to identify if there are any variety imbalances driving disorder in your system and if there are, from where do they originate? Is it the workload between the environment and the operational units of your system that is causing a problem? Is there disorder between the operational units themselves? Could it be that there is an imbalance between the autonomy required to innovate and the cohesion required to maintain your identity? Is the rate of change causing a problem; is there an imbalance between changing at a pace to match the environmental variety and yet maintaining the current status quo?

Looking for requisite variety in all of these areas of potential critical variety imbalance has been a very powerful approach for me in my work. I am able to recognise the resource conflicts and the turf wars between clinical teams, indicative of issues in co-ordination mechanisms (knows as system 2 of the VSM). I am able to identify if there is a common sense of purpose, what the structural couplings are and what kind of identity this creates. I know what pathologies to look out for, for it is the pathologies that indicate that my system is sick.

We can only manage organisation if we know how it works. The VSM helps us to understand how it works. It guides us to consider what value our system provides to its environment and the things it does to keep itself in existence. It helps us to decide if primary activities are split by: task, customers, geography or time. It guides us in explicitly identifying mechanisms that enable primary activities to run smoothly. It gives us a platform from which to examine resource bargains and identify control dilemmas. It allows us to understand the type and nature of monitoring loops that are effective and those that break the bond of trust. It encourages us to link performance measurement in a meaningful way. It encourages us to gather intelligence from outside of the system and guides us in making better decisions.

I have used it, in combination with other systems thinking methods and concepts, to identify and reduce quality incidents in health services, to redesign pathways, to identify where and why services have been underperforming and help them improve,  to evaluate strategy and to form strategy, to decide whether to re-commission or decommission and to build new services from scratch.

So, after a tentative introduction to each other, the VSM and I get along just fine nowadays. In fact, I believe it is one of the single most powerful models I have ever used to help me understand a situation, diagnose weakness in a situation or design something from scratch. It gives me the skills to make better choices. It helps me understand why a situation is like it is, taking away any preconceived ideas and prejudices. It makes me feel at ease working with large, messy social situations and supports me in identifying problems and opportunities. VSM is no longer standing in the corner of my party…..it’s dancing, right in the middle of the floor!

 “… vision without systems thinking ends up painting lovely pictures of the future with no deep understanding of the forces that must be mastered to move from here to there.” Peter M Senge, The Fifth Discipline.